Fever | Ear Infections | Strep Throat | Antibiotics | Vaccines FEVER Fever is the single most common reason for kids’ sick visits to their doctors. The typical child may have as many as 10 fever illnesses each year in the first years of life; that’s known as physician job security. Most fevers are due to infections and many infections are associated with fevers. Fever may accompany many common infections in kids - colds, ear infections, the flu, the stomach flu, etc. But, when fever is the dominant symptom of a child’s illness, perhaps along with trivial symptoms like a runny nose, slight cough, or non-distinctive rash, the cause of the fever is a virus 97% of the time. Because of the 3% chance of a more serious bacteria disease, particularly in the youngest infants, fever generates substantial attention and activity on the part of parents and physicians alike. What constitutes a fever? A fever is defined as a temperature elevation greater than or equal to 100.4 degrees Fahrenheit (38 degrees Centigrade) measured rectally; other methods of taking body temperature are less accurate. Temperature elevations less than that are of less concern for serious infection (with the possible exception of babies younger than 2 months of age where even lesser temperature elevations may herald serious infection). There is a trend, also, for a higher occurrence rate of serious infections (usually bacterial) with very high fevers (greater than or equal to 104.0 degrees Fahrenheit; 40 degrees Centigrade); still, 80-90% of kids with even very high fevers have benign viral illnesses that get better on their own. Fevers are indicators of underlying infection, but fever in and of itself is not harmful – and is probably beneficial in helping the body fight infection. Because kids with fevers are miserable, we tend to use medicines like acetaminophen and ibuprofen to bring down elevated temperatures and make kids feel better. The theoretical benefit of fever in helping fight infection is not so great that it warrants withholding treatments that can make kids less miserable. If your child has fever, and unless otherwise instructed by a doctor, it’s okay to bring the fever down. When a baby under 2 months of age develops a fever, most physicians automatically hospitalize and treat with intravenous or intramuscular antibiotics until bacterial infection can be ruled out by a series of tests on the blood, urine, and spinal fluid. Fever is a “hospitalizable offense” in these very young babies because bacterial infection in general can be more serious and progress more rapidly than in older kids. The specific bacteria that cause infections in babies younger than 3 months can be more dangerous than the bacteria that cause infections in older kids, and younger babies don’t do as well in limiting the spread of infection within their bodies. When an older infant or child, between the ages of 2 or 3 months and 2 years, develops a fever without clear cause (without an obvious ear infection, for example), some physicians will do testing – blood, and sometimes urine or spinal tap – to help determine the likelihood of bacterial infection; other physicians will rely on their clinical experience and observation skills to distinguish between benign viral illnesses and more worrisome bacterial infections. If testing is done and raises concerns, antibiotic treatment and/or hospitalization will be considered. Beyond 2 years of age, how your child looks to the doctor is the most important factor determining the doctor’s action. Because such a high percentage of fevers are caused by benign viruses that get better on their own, few kids older than 2 years need aggressive diagnosis or specific therapy if they look otherwise well to their doctor. Antibiotics don’t treat viral infections and therefore should not be given to the vast majority of kids with fevers. How contagious is it?
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Copyright 2007, Dr. Harley A. Rotbart. Guidelines for Parents from the new book, Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, 2008). Read Dr. Rotbart’s GERMBlog for frequent updates on important germ issues for your kids |
